The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations and conclusions are based primarily on consensus and expert opinion (Level C):
- Uterotonic agents should be the first-line treatment for postpartum hemorrhage due to uterine atony.
- Management may vary greatly among patients, depending on etiology and available treatment options, and often a multidisciplinary approach is required.
- When uterotonics fail following vaginal delivery, exploratory laparotomy is the next step.
- In the presence of conditions known to be associated with placenta accreta, the obstetric care provider must have a high clinical suspicion and take appropriate precautions.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
